Using Technology to Bring the Human Element Back to Healthcare – An Interview with Dr. John M. Ciccone
With today’s health technologies lagging behind consumer-driven innovations, health IT needs to be completely reprioritized, and move towards helping people take better care of people.
Experienced healthcare providers are the ones who have seen the direct impact health IT has had on patients, and caregivers overall. They also have the deepest expertise and insights into how we can chart a better path forward.
This is why the editorial team of Health & Care Perspectives was excited to sit down with Dr. John M. Ciccone. A practicing cardiologist since 1982 and leading advocate for better health IT, Dr. Ciccone started his career in New Jersey and moved to South Carolina in 2012. He is board certified by the American Board of Internal Medicine in Cardiology in Integrative and Holistic Medicine.
Dr. Ciccone has years of experience in the medical trenches wrestling with EHRs. These cumbersome systems are often built on antiquated technologies that actually can hurt, not help, physicians and nurses. Caregivers need to be spending more time with patients, rather than on administrative tasks.
The following conversation has been edited for length.
Health & Care Perspectives: Why haven’t advances in IT unlocked efficiencies in health care as in other industry verticals?
Dr. Ciccone: It’s because most EHRs were and are constructed as sophisticated billing systems. If you read the EHR notes carefully, there isn’t a lot of significant information about the patient, it’s mostly how to code the billing accurately. It’s a fundamental flaw of EHRs and a huge drawback.
The inefficiencies undercut the ability of health IT to assist care. Technology actually gets in the way of care, rather than supporting it. Studies show that it takes specialists an average of 16 minutes to enter patient information into an EHR, and a primary care doctor even more, 19 minutes. That’s most of a half hour patient visit!
It should be the other way around – a few minutes with the IT and most of the visit face-to-face with the patient. The lack of eye contact today also leads to patients feeling ignored by their care providers.
In addition, legacy EHRs were designed by IT programmers who were very good at their jobs, yet had an inadequate understanding of physician workflows.
Health & Care Perspectives: What benefit does a reimagined EHR hold for providers of care?
Dr. Ciccone: There are many benefits to a reimagined EHR. For example, it needs to be designed with an interface that is intuitive and user-friendly. This will reduce documentation burden, and allow the provider to truly focus on the patient.
The reimagined EHR should also have a common patient framework that offers a consistent look and feel for all departments and roles – enhancing training and ease-of-use by everyone in a care facility.
Overall, this will help to address the major challenge of physician burnout. The last thing doctors want is to be encumbered by intrusive electronic paperwork. It’s the biggest contributing factor to burnout. Most EHRs have not been constructed for healthcare workflows. Changing your workflow to suit the needs of an EHR is backwards and stressful, yet that is exactly what doctors are forced to do today.
Health & Care Perspectives: What’s one single improvement that could improve the typical EHR?
Dr. Ciccone: Number one would be simply making sign-in easier. If some kind of biometric sign-in could be designed, it would be a huge help. It sounds basic but entering in complicated passwords dozens of times a day is distracting and cumbersome.
Another improvement would be accurate templates based on doctor specialty. Most EHR templates are built for primary care uses, and there is a lot of extraneous information specialists have to wade through to use the tool. Even a few clicks per process really add up.
Imagine multiplying three extra clicks for each entry, 40 average entries per patient, an average of 25 patients per day and you get the idea!
Health & Care Perspectives: How has the move to value-based care impacted EHRs?
Dr. Ciccone: The move to value-based care is a tremendous opportunity. In order to create value, you need a certain volume of patients. More efficient EHRs improve access to caregivers. Inefficiency prevents seeing enough patients each day, which decreases access to care and increases costs.
Value-based care relies on processes becoming more seamless and more accurate. When the data is accurate, you obviously have less mistakes and complications in patient care. You can also start to bring in artificial intelligence (AI) and apply it to population health research and insights into efficient patient care.
Health & Care Perspectives: How would an improved EHR assist collaboration amongst providers?
Dr. Ciccone: Access to all relevant patient information can prevent mistakes and unnecessary duplication in care. It’s simple to describe, but maddeningly hard to make happen in the current health IT environment.
Here’s a specific example – a stroke victim comes to see me. He has already seen his neurologist, but I don’t have access to those notes. It should never be on the patient to communicate complicated diagnostic information to another specialist.
So, without that information, I might order unnecessary tests or put the patient on unnecessary medication – a blood thinner for example which might not be needed.
Health & Care Perspectives: What’s the importance of EHRs being open platform rather than closed?
Dr. Ciccone: It’s very important that the customer can make some changes to their EHR themselves, rather than having to work with the vendor for development. Too many EHRs today are “a la carte,” and every small tweak represents additional costs.
What’s needed are customer success teams that work collaboratively with facilities from day one to determine what system needs are, then build around those needs and desires so the product is intuitive. It’s also important to note that training and support isn’t provided with current EHR products. A level of customization could be included at no additional cost to ensure that a reimagined EHR truly supports and never hinders the delivery of care.
Health & Care Perspectives: What do you see happening with EHRs in the next 12-18 months?
Dr. Ciccone: We’re starting to see a move to more nimble systems that are friendlier for both doctors and patients. Virtual visits have been a catalyst for this move, which in turn provide additional analytics for population health strategies.
Better population health strategies can result in huge cost-savings. Take for example congestive health patient readmits, which are very costly. Without clear clinical pathways, it is not possible to distinguish the patients that are highly compliant with their care from the less compliant “frequent flyers.” With accurate data, facilities can take resources that would have been spent on 500 patients and focus more on the 30 that are likely to be the sickest.
At Roper St. Francis in Mount Pleasant, a .1 percent decrease in the average length of a stay equated to one million dollars in savings per year. The effect can be that dramatic once the data tells you where to focus your time and resources.
EHRs that support this move to better population health will thrive, and the ones that can’t will lose market share.
Health & Care Perspectives: Anything else you’d like to add about the human element of care?
Dr. Ciccone: I’d just like to reinforce the point that the current state of EHRs has severed the personal connection between doctors and patients. And severed it between nurses and patients as well.
Personal connection develops trust, and trust builds better communication and leads to real conversations that can lead to insight into issues and how to deal with them. I can’t tell you the times that real conversations with patients revealed potential health issues and ways to better deal with those issues.
And I’d say it’s even more powerful on the nursing side. Nurses need to make assessments on every patient and being distracted by cumbersome technology detracts from care. Nurses need enough time to provide education at the bedside, one of their most critical functions. If the nurse is distracted or overburdened, that shows up in negative HCAHP scores for the facility. And that stress and frustration drives turnover, negatively impacting nurse retention.
We would like to thank Dr. Ciccone for participating in this Health & Care Perspectives Q&A interview. Dr. Ciccone is board certified by the American Board of Internal Medicine in Cardiology, and is board certified in Integrative and Holistic Medicine. He also has nearly 40 years of experience, and currently serves as CMO for DSS, Inc.
If you are a healthcare IT leader or a provider with insights to share about how we can collectively bring the human back to care, please contact us here, and our editorial team will set up an interview.